Complex Venous Leg Ulcer with Underlying DVT and Factor V Leiden Healed Using Novel Omega Fatty Acids Based Therapy

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Abstract

Complex Venous Leg Ulcer with Underlying DVT and Factor V Leiden Healed Using Novel Omega Fatty Acids Based Therapy
Jacob Reinkraut, DPM, FACFAS 1, Adeen Khokhar, DPM, PGY-31, Sarah Abdou, DPM PGY-21, Sonya Wali, DPM PGY-11, Desmond Bell, DPM, CWS, FF RCPS (Glasgow)2
1 St. Michael’s Medical Center, Newark, NJ
2 The Save a Leg, Save a Life Foundation

Introduction
Venous leg ulcerations (VLU’s) account for a minimum of 70% of chronic wounds (1). Delayed healing is associated with VLU’s greater than 10cm2 and three months or greater in duration (1, 2). Annual cost of care in the US is estimated to be $16 billion (1). The ability to accelerate healing while reducing costs can help curtail some of this expense. Presented here is a case report of a chronic VLU that resolved in under three months with use of an omega-based complete care protocol used once weekly in an outpatient setting.

Case Report
A 54-year-old African American male with a VLU of 5 months duration presented with failure to heal and 10/10 pain requiring oral analgesic use. The patient had previously undergone surgical debridement and xenograft application. Weekly treatment with an anhydrous omega-based bundle product package focused on wound and periwound preparation prompted healing to begin. Pain rapidly resolved and wound resolution occurred at 11 weeks.

Discussion
High-quality studies on advanced tissue product use in the treatment of VLU’s report healing rates between 44 to 84% at 12-weeks (average baseline size ~6cm2) (1-6). None of these modalities address the periwound skin which is often in poor condition after months of weekly compression dressing use. Preclinical trials of therapies utilizing omega-3 polyunsaturated fatty acids show reduced inflammatory cell recruitment, enhanced perfusion, decreased bacterial growth and disruption of biofilm (7 - 16). Their use also provides protection and improved texture to the periwound skin. This may help propel chronic wounds towards resolution and potentially mitigate wound recurrence.

Conclusion
Use of an omega-based complete care protocol resulted in expedited resolution of a chronic venous leg ulceration in a patient that had failed prior advanced treatment modalities.

References

  1. Mostow EN, Haraway GD, Dalsing M, Hodde JP, King D; OASIS Venus Ulcer Study Group. Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial. J Vasc Surg. 2005 May;41(5):837-43. doi: 10.1016/j.jvs.2005.01.042. PMID: 15886669.
  2. Parker CN, Finlayson KJ, Shuter P, Edwards HE. Risk factors for delayed healing in venous leg ulcers: a review of the literature. Int J Clin Pract. 2015 Sep;69(9):1029-30. doi: 10.1111/ijcp.12677. PMID: 26311330.Marston et al. J Vasc Surg Venous Lymphat Disord. 2017 Nov;5(6):829-835.e1. – risk factors
  3. Falanga V, Margolis D, Alvarez O, Auletta M, Maggiacomo F, Altman M, Jensen J, Sabolinski M, Hardin-Young J. Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Human Skin Equivalent Investigators Group. Arch Dermatol. 1998 Mar;134(3):293-300. doi: 10.1001/archderm.134.3.293. PMID: 9521027.
  4. Falanga V, Sabolinski M. A bilayered living skin construct (APLIGRAF) accelerates complete closure of hard-to-heal venous ulcers. Wound Repair Regen. 1999 Jul-Aug;7(4):201-7. doi: 10.1046/j.1524-475x.1999.00201.x. PMID: 10781211.
  5. Serena TE, Carter MJ, Le LT, Sabo MJ, DiMarco DT; EpiFix VLU Study Group. A multicenter, randomized, controlled clinical trial evaluating the use of dehydrated human amnion/chorion membrane allografts and multilayer compression therapy vs. multilayer compression therapy alone in the treatment of venous leg ulcers. Wound Repair Regen. 2014 Nov-Dec;22(6):688-93. doi: 10.1111/wrr.12227. Epub 2015 Jan 8. PMID: 25224019.
  6. Bianchi C, Cazzell S, Vayser D, Reyzelman AM, Dosluoglu H, Tovmassian G; EpiFix VLU Study Group. A multicentre randomised controlled trial evaluating the efficacy of dehydrated human amnion/chorion membrane (EpiFix® ) allograft for the treatment of venous leg ulcers. Int Wound J. 2018 Feb;15(1):114-122. doi: 10.1111/iwj.12843. Epub 2017 Oct 11. PMID: 29024419.
  7. Komprda T, Sladek Z, Sevcikova Z, Svehlova V, Wijacki J, Guran R, Do T, Lackova Z, Polanska H, Vrlikova L, Popelkova V, Michalek P, Zitka O, Buchtova M. Comparison of Dietary Oils with Different Polyunsaturated Fatty Acid n-3 and n-6 Content in the Rat Model of Cutaneous Wound Healing. Int J Mol Sci. 2020 Oct 24;21(21):7911. doi: 10.3390/ijms21217911. PMID: 33114430; PMCID: PMC7672592.
  8. Ishak WMW, Katas H, Yuen NP, Abdullah MA, Zulfakar MH. Topical application of omega-3-, omega-6-, and omega-9-rich oil emulsions for cutaneous wound healing in rats. Drug Deliv Transl Res. 2019 Apr;9(2):418-433. doi: 10.1007/s13346-018-0522-8. PMID: 29667150.
  9. Peng YC, Yang FL, Subeq YM, Tien CC, Chao YC, Lee RP. Lipid Emulsion Enriched in Omega-3 PUFA Accelerates Wound Healing: A Placebo-Controlled Animal Study. World J Surg. 2018 Jun;42(6):1714-1720. doi: 10.1007/s00268-017-4404-x. PMID: 29264725.
  10. Babaei S, Nakhaei M, Ansarihadipour H, Sakhaei M, Hosseini S, Nikgoftar A. Omegaven Improves Skin Morphometric Indices in Diabetic Rat Model Wound Healing. J Am Coll Clin Wound Spec. 2018 Apr 28;9(1-3):39-45. doi: 10.1016/j.jccw.2018.04.001. PMID: 30591901; PMCID: PMC6304289.
  11. Silva JR, Burger B, Kühl CMC, Candreva T, Dos Anjos MBP, Rodrigues HG. Wound Healing and Omega-6 Fatty Acids: From Inflammation to Repair. Mediators Inflamm. 2018 Apr 12;2018:2503950. doi: 10.1155/2018/2503950. PMID: 29849484; PMCID: PMC5925018.
  12. Jia YC, Qiu S, Xu J, Kang QL, Chai YM. Docosahexaenoic Acid Improves Diabetic Wound Healing in a Rat Model by Restoring Impaired Plasticity of Macrophage Progenitor Cells. Plast Reconstr Surg. 2020 May;145(5):942e-950e. doi: 10.1097/PRS.0000000000006739. PMID: 32332536.
  13. Blondeau N, Pétrault O, Manta S, Giordanengo V, Gounon P, Bordet R, Lazdunski M, Heurteaux C. Polyunsaturated fatty acids are cerebral vasodilators via the TREK-1 potassium channel. Circ Res. 2007 Jul 20;101(2):176-84. doi: 10.1161/CIRCRESAHA.107.154443. Epub 2007 Jun 7. PMID: 17556656.
  14. Matheson PJ, Hurt RT, Mittel OF, Wilson MA, Spain DA, Garrison RN. Immune-enhancing enteral diet increases blood flow and proinflammatory cytokines in the rat ileum. J Surg Res. 2003 Apr;110(2):360-70. doi: 10.1016/s0022-4804(03)00033-7. PMID: 12788666.
  15. Coraça-Huber DC, Steixner S, Wurm A, Nogler M. Antibacterial and Anti-Biofilm Activity of Omega-3 Polyunsaturated Fatty Acids against Periprosthetic Joint Infections-Isolated Multi-Drug Resistant Strains. Biomedicines. 2021 Mar 26;9(4):334. doi: 10.3390/biomedicines9040334. PMID: 33810261; PMCID: PMC8065983.
  16. Kim YG, Lee JH, Raorane CJ, Oh ST, Park JG, Lee J. Herring Oil and Omega Fatty Acids Inhibit Staphylococcus aureus Biofilm Formation and Virulence. Front Microbiol. 2018 Jun 15;9:1241. doi: 10.3389/fmicb.2018.01241. PMID: 29963020; PMCID: PMC6014104.

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